Influence of basic complex two-year therapy on indicators of late remodeling of the left ventricle and prophylaxis of the occurrence of cardiovascular events in patients after unstable angina combined with arterial hypertension

Authors

  • O. V. Denesiuk National Pirogov Memorial Medical University, Vinnytsia, Ukraine,
  • V. I. Denesiuk National Pirogov Memorial Medical University, Vinnytsia, Ukraine,

DOI:

https://doi.org/10.14739/2310-1237.2019.2.177198

Keywords:

unstable angina pectoris, cardiac remodeling, treatment

Abstract

 

The purpose of the study was to determine the effect of basic complex biennial treatment on the parameters of late remodeling of the left ventricle (LV) and cardiovascular events in patients after unstable angina (UA) in combination with arterial hypertension (AH).

Materials and methods. A total of 144 patients with unstable angina in combination with arterial hypertension, at the age of 41–67 years, who were treated in the infarct department of City Clinical Hospital № 1 in Vinnytsya, who had a history of myocardial infarction in 59.7 % of cases, were examined. The duration of hypertension was 9.3 years on average, chronic CHD – 6.4 years; systolic blood pressure – 163.2 ± 1.50 mm Hg, diastolic blood pressure – 101.1 ± 0.67 mm Hg. The patients underwent general clinical examination, ECG, echocardiography in M- and B-regimens, lipid blood spectrum and troponin I. The examinations were carried out before treatment, after 6, 12 and 24 months. Basic complex treatment was carried out for two years with perindopril 5–10 mg/day, bisoprolol 5–10 mg/day, atorvastatin 20 mg/day and acetylsalicylic acid 75 mg/day.

Results. In the examined patients after thе UA in combination with hypertension before the treatment concentric left ventricular hypertrophy (LVH) according to A. Genau was determined in 40.3 %, eccentric – in 58.3 %, concentric remodeling – in 1.4 %. After conducting the basic comprehensive treatment, the concentric LVH decreased and the eccentric increased.

In patients after UA in combination with hypertension before treatment I (initial) degree of LVH was determined in 6.3 %, II (moderate) – 26.4 %, III (significant) –in 66.7 %. After the basic comprehensive treatment, the third (significant) level of LVH significantly decreased due to the gradual transition to the second and the first stage of late remodeling of the LV. While studying the development of cardiovascular events it was found, that two years mortality was 2.1 %, recurrent not fatal myocardial infarction was registered in 10.4 % of cases.

Conclusions. In patients after the UA in combination with hypertension conducted two-year basic complex antiremodeling treatment was accompanied in a number of cases by the transition of concentric remodeling of LV to the eccentric one and a reducеion in risk of cardiovascular events development.

References

Agmadova, Z. M., & Kallaeva, A. N. (2014) Osobennosti remodelirovaniya miokarda u bol'nykh s razlichnymi formami nestabil'noj stenokardii [Special Characteristics of Progression of Myocardial Remodeling in Patients With Various Forms of Unstable Angina]. Cardiologiya, 2014, 54(7), 9–16. [in Russian].

Babij, L. N., Stroganova, N. P., & Khomenko Yu. O. (2015) Rannee i pozdnee remodelirovanie levogo zheludochka serdca u bol'nykh s uspeshnoj eʹndovaskulyarnoj rekanalizaciej infarktoobuslovlivayushhej venechnoj arterii [Early and later remodeling of the left ventricle of the heart in patients with successful endovascular recanalization of the infarctosurgical coronary artery]. Kardiokhirurhiia ta interventsiina kardiolohiia, 2, 26–32. [in Russian].

Bilovol, O. M., & Kravchun, P. P. (2015) Otsinka oznak ta variantiv postinfarktnoho remodeliuvannia u khvorykh na postinfarktnyi kardioskleroz. [Evaluation of signs and types of postinfarction remodeling in patients with postinfarction cardiosclerosis]. Ukrainskyi terapevtychnyi zhurnal, 2015, 1, 37–40. [in Ukrainian].

Denesiuk, V. I., & Denesiuk, O. V. (2012) Rozvytok endotelialnoi dysfunktsii, remodeliuvannia sudyn ta dyslipidemiia u khvorykh na nestabilnu stenokardiiu z komorbidnoiu arterialnoiu hipertenziieiu [Development of endothelial dysfunction, vascular remodeling and dyslipidemia in patients with unstable angina with comorbid arterial hypertension]. Krovoobih ta hemostaz, 4, 57–61. [in Ukrainian].

(2015) Lechenie arterial'noj gypertenzii u pacientov s ishemicheskoj bolezn'yu serdca АНА/АСС/ASH 2015 [Treatment of hypertension in patients with coronary heart disease. ANA/ACC/ASH 2015]. Novosti mediciny i formacii, 8(539), 22–26. [in Russian].

Mareev, V. Yu., & Mareev, Yu. V. (2015) Metody profilaktiki vnezapnoj serdechnoj smerti pri khronicheskoj serdechnoj nedostatochnosti [Methods of Prevention of Sudden Death in Chronic Heart Failure]. Kardiologiya, 55(9), 72–83. [in Russian].

Mishina, I. E., Dovgalyuk, Yu. V., Mazanko, O. E., Lebedev, L. V., & Berezin, M. V. (2012). E'ffektivnost' perindoprila v kompleksnoj kontroliruemoj ambulatornoj terapii bol'nykh, perenesshikh ostryj koronarnyj sindrom [Efficiency of perindopril in complex controlled outpatient therapy of patients with acute coronary syndrome]. Consilium Medicum, 10, 45–47. [in Russian].

Denesyuk, O. V., Denesyuk, O. V., Afanasyuk, O. I., et al. (2013) Patent na korysnu model №86395. MPK(2013.01) A61V 5/00 Sposib diahnostyky hipertrofii livoho shlunochka z sertsevo-sudynnymy zakhvoriuvanniamy [Patent for Utility Model No. 86395. IPC (2013.01) A61V 5/00 Method of diagnosis of left ventricular hypertrophy with cardiovascular diseases]. Bull., 24. [in Ukrainian].

Tseluyko, V. Y., Lozova, T. A., & Martsovenko, I. M. (2017) Gendernye osobennosti techeniya ostrogo perioda i dolgosrochnogo prognoza bol'nykh s infarktom miokarda pravogo zheludochka na fone infarkta miokarda s zubcom Q zadnej stenki levogo zheludochka [Gender features of an acute course and long-term prognosis of patients with myocardial infarction of the right ventricle against the background of Q-myocardial infarction of the left ventricle posterior wall]. Sertse i Sudyny, 3, 61–66. [in Russian].

Konyli, A., Sarszegi, Hild, G., et al. (2016) Bezopasnost' i e'ffektivnost' kombinacii antigipertenzivnoj i kholesterinosnizhajushhej terapii u pacientov iz gruppy vysokogo/ochen' vysokogo riska [The safety and efficacy of a combination of antihypertensive and cholesterol-lowering therapy in patients from the high / very high risk group]. Liky Ukrainy, 7–8(203–204), 59–67. [in Ukrainian].

Potier, L., Roussel, R., Filbez, Y., et al. (2017) Ingibitory angiotenzinprevrashhayushhego fermenta i blokatory receptorov angiotenzina pri vysokom riske sosudistykh oslozhnenij [Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers with a high risk of vascular complications]. Therapia, 11–12, 21–28. [in Russian]/

Whelton, P. K., Carey, R. M., Aronow, W. S., et al. (2018) Rekomendatsii shchodo profilaktyky vyiavlennia otsinky vysokoho krovianoho tysku v doroslykh ta upravlinnia nym: dopovid Amerykanskoho koledzhu kardiolohiv/ Amerykanskoi asotsiatsii sertsia [Guidelines for Preventing and Managing High Blood Pressure in Adults: A Report from the American College of Cardiology / American Heart Association. News of Medicine and Pharmacy, 2(640), 3–4. [in Ukrainian].

How to Cite

1.
Denesiuk OV, Denesiuk VI. Influence of basic complex two-year therapy on indicators of late remodeling of the left ventricle and prophylaxis of the occurrence of cardiovascular events in patients after unstable angina combined with arterial hypertension. Pathologia [Internet]. 2019Sep.2 [cited 2024Mar.29];(2). Available from: http://pat.zsmu.edu.ua/article/view/177198

Issue

Section

Original research